2013 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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ADVANTAGE Preferred (PPO) - H5508-002-0 Benefit Details |
Blackford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
ADVANTAGE Select (PPO) - H5508-005-0 Benefit Details |
Blackford | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Care Improvement Plus Copper RX (PPO SNP) - H0084-034-0 Benefit Details |
Blackford | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx (PPO SNP) - H0084-015-0 Benefit Details |
Blackford | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Medicare Advantage (PPO) - H0084-017-0 Benefit Details |
Blackford | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,900 Browse Formulary | |||||
HumanaChoice R5826-066 (Regional PPO) - R5826-066-0 Benefit Details |
Blackford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
IU Health Plans Medicare Select (HMO) - H7220-002-0 Benefit Details |
Blackford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
Blue Medicare Access Value (Regional PPO) - R5941-009-0 Benefit Details |
Blackford | $34.00 | $80 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Injectable Drugs: 33% Specialty Tier: 33% | $6,500 Browse Formulary | |||||
Care Improvement Plus Chrome RX (PPO SNP) - H0084-033-0 Benefit Details |
Blackford | $37.20 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Dual Advantage (PPO SNP) - H0084-016-0 Benefit Details |
Blackford | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
Care Improvement Plus Silver Rx (PPO SNP) - H0084-014-0 Benefit Details |
Blackford | $37.20 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
ADVANTAGE Choice (PPO) - H5508-006-0 Benefit Details |
Blackford | $39.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
IU Health Plans Medicare Select Plus (HMO) - H7220-003-0 Benefit Details |
Blackford | $54.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $4,500 Browse Formulary | |||||
Today's Options Premier 600 (PFFS) - H6169-015-0 Benefit Details |
Blackford | $64.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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HumanaChoice R5826-008 (Regional PPO) - R5826-008-0 Benefit Details |
Blackford | $66.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
ADVANTAGE Enhanced (PPO) - H5508-001-0 Benefit Details |
Blackford | $84.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,000 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) - H7220-004-0 Benefit Details |
Blackford | $98.00 | $0 | Many Generics | Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $3,950 Browse Formulary | |||||
Today's Options Premier 300 (PFFS) - H6169-052-0 Benefit Details |
Blackford | $100.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Today's Options Premier Plus 650C (PFFS) - H6169-035-0 Benefit Details |
Blackford | $106.00 | $75 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
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Humana Gold Choice H8145-012 (PFFS) - H8145-012-0 Benefit Details |
Blackford | $172.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $13.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Today's Options Premier Plus 350A (PFFS) - H6169-056-0 Benefit Details |
Blackford | $172.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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